Posted 01 June 2012 - 08:26 AM
It may seem weird that I'm trying to offer advice, given that I'm diagnosed with hypersomnia, but my sleep has been generally out of whack in all kinds of ways since long before my current set of symptoms.
First of all, if you've tried to force yourself to a normal rhythm and it simply does not work no matter what you do, then naps may be something to consider. Like allieincrazyland said, some sleep is better than none, even if you have to get it in an erratic pattern. This isn't possible for everyone for practical reasons, but as a student with hypersomnia/narcolepsy, I found it actually quite helpful. If you get tired or sleepy at an unusual time, but you do actually have some time to spare, then lying down can really help. For people who are trying to make sure their sleep schedule is 'normal', avoiding naps is good, but if you're not sleeping at night anyway, it's not like there's any circadian rhythm to disturb.
As for old wives' tales, I know this may sound useless and patronizing, and if someone suggested this to me I'd probably swat them. However, one of the things that I've found really surprisingly helpful was wearing a sleep mask. I tried it in hopes of decreasing the amount of time it would take me to fall asleep, but what I found was that on nights that I wore the sleep mask, I'd actually wake up the next morning before my alarm feeling totally refreshed. My insomnia at the time was nowhere near as severe as yours, so the effect of a sleep mask may be negligible on you, but I figure it's worth mentioning - mainly because I was so surprised at exactly how helpful it was.
Sleep study: worth it. Trust me. I know it may be a point of anxiety for you, but it's absolutely worth it to try to work through any negative feelings you might have around it. Sleeping in the lab is really not as weird as you might assume. The room looks more like a hotel room than anything, and you're in your own clothes/pajamas, and it feels much less medical than you expect. If you're concerned you might not be able to sleep as well, but also concerned that your doctors don't take your word for it about how serious your insomnia is, then this is kind of a benefit, if anything - they'll have empirical proof that you are as sleepless as you say you are, or perhaps even more so.
Tired vs sleepy. This is something I'm always trying to explain to non-sleep-disordered friends. If you are feeling tired, then it may be worth having a lie down without even trying to get to sleep; it doesn't matter if you sleep or not - resting yourself will help with tiredness.
Lastly, how long exactly has your insomnia been this bad? Was it always like this? If not, was the onset of this level of severity correlated with any chance in medication, diet, general health, etc.? Also, someone else mentioned [hypo]mania, which is something to consider as well - if you've had any other symptoms of it, etc.
Notes about my diagnoses:
The psychiatrist's letter reads 'Recurrent depression - currently moderate depression'. Officially, I also have idiopathic hypersomnia, but that's only because I flunked the narcolepsy test; if they hadn't caught me on a good day, the diagnosis would be narcolepsy without cataplexy.
Current prescription: dextroamphetamine 10mg/day, fluoxetine 20mg/day (to be increased to 40)
Previous prescriptions: escitalopram (2006-07), fluoxetine (June 2011-Jan 2012), venlafaxine (January-May 2012).
Stopped escitalopram because I moved to England from the US and my new idiot doctor decided that a fourteen-year-old couldn't possibly need medication. Stopped fluoxetine (which worked at first) because the depression came back, badly. Stopped venlafaxine because it sucked ass. Back on fluoxetine because we know it won't make me any more nuts than I am already, and also so that I'm not suddenly going medless in the middle of exam season.